A recent review of published findings related to rheumatoid arthritis and hearing loss was released. The stated purpose of this review is to examine the cause, or pathology, of hearing loss in rheumatoid arthritis patients as well as to discuss management.
What is Rheumatoid Arthritis?
Rheumatoid Arthritis, or RA, is an autoimmune inflammatory disease. This means the patient’s own immune system attacks certain cells within the body causing pain and inflammation. It impacts everything from joints to major organs. RA is a chronic disease with no known cure.
How is Rheumatoid Arthritis Related to Hearing Loss?
Because the swelling and inflammation caused by RA can impact all parts of the body, it can effect hearing as well. To better understand this connection, let’s look at how hearing works.
Hearing is a complex process. When sound first travels into the ear it first moves through the eardrum where sound is converted into vibrations. These vibrations then move through tiny bones and ear fluid and eventually reach the small hair cells of the inner ear. These hair cells work to make and send electrical signals to the auditory nerve. All of this input is then translated by the brain into sounds we recognize.
This impressive system has many components and therefore many areas for RA to disrupt the process. To look at the possible pathologies of hearing loss with RA, we will break them down into the types of hearing loss.
- Conductive hearing loss occurs in the outer and middle ear. It is typically caused by obstructions such as ear wax that can be removed however when RA impacts this portion of the ear it can be caused by several factors.
- Joints– Between the tiny bones of the ear lies the incudostapedial (IS) and incudomalleolar (IM) joints. These are prone to the same inflammation of joints as in other parts of the body. If the swelling becomes too much it can block the middle ear.
- Rheumatoid nodules– Rheumatoid nodules are a common issue for those with RA. They are hard lumps that appear just under the skin. If a rheumatoid nodule occurs in the ear canal, it can cause conductive hearing loss.
- Sensorineural hearing loss occurs in the inner ear. It can be caused by age, noise exposure, medications, and other factors. Sensorineural hearing loss specifically caused by the effects of RA are listed below.
- Auditory neuropathy– When swelling and inflammation happen to blood vessels, it is called vasculitis. Vasculitis around the auditory nerve can cause a disruption to the hearing process leading to sensorineural hearing loss.
- Damage to hair cells– Immune complex deposition of RA leads to the destruction of the hair cells in the inner ear. Without the full use of the small hair cells in the inner ear, transmission to the auditory nerve is interrupted.
- Medications– Several medications used to treat the symptoms of RA are known to be ototoxic. Ototoxicity, or ear poisoning, can cause hearing loss. While it is sometimes permanent, it may be possible to reduce or reverse the ototoxic symptoms with a change to the medication or dose.
- Mixed hearing loss, as the name suggests, is a combination of sensorineural and conductive hearing loss. This means the patient is experiencing symptoms of RA in both the inner ear and the middle or outer ear.
Additionally, there are multiple environmental factors that can aggravate the symptoms of RA such as smoking, alcohol consumption, and noise exposure.
Treatment for Hearing Loss Related to Rheumatoid Arthritis
Because hearing loss related to RA is multifactorial, the treatment options vary as well. A common treatment option of RA is the use of immunosuppressant medications that can help to reduce some of the painful inflammatory symptoms related to RA. This reduction in inflammation can help prevent RA’s impact to the ear and therefore hearing. Changing medications and doses if the patient is experiencing an ototoxic symptoms is another option.
In the event that hearing loss has already occurred and there are no other treatment options available, then the management of hearing loss would likely include hearing aids. Hearing aids can be programmed to fit each unique person’s hearing loss from mild to severe.
If you have RA and are concerned about possible hearing changes, speak to a hearing health provider.